![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Racer on December 13, 2007, at 10:52:30
In reply to need help,please. Minimum dose too strong, posted by Meagan on December 13, 2007, at 10:35:49
Some here will say to open the capsules and count out grains of the drug. Personally, I would say stick it out on the 20mg capsules, and just remind yourself that the adjustment phase issues are likely to pass. I know it's hard -- been there, doing that now with a new drug myself -- but it is possible.
One reason that I suggest sticking with the 20mg capsule, rather than trying to split the dose, is that it may shorten the adjustment phase for you. If you split the capsules, you'll end up going through the adjustment at every increase, which can take much longer. Sticking with the full 20mg from the start means going through ONE adjustment period. For me, the convenience and the shortened adjustment are just easier to deal with.
I know it's hard to do, because -- as I've said -- I've done it myself. And I'm doing it now. My therapist and I talk about the difficulties of sticking it out, and I have a few BabbleBuddies I discuss it with. I think we should form a little Sticking It Out club on the board, so you're welcome to join us...
Posted by Meagan on December 13, 2007, at 11:11:53
In reply to Re: need help,please. Minimum dose too strong, posted by Racer on December 13, 2007, at 10:52:30
Thank you Racer, your posting came just when I desperately needed it; what you say makes sense - about sticking it out - thank you for your words of encouragement, especially at a time when you are going through a similar process yourself.
I like your idea of a Sticking It Out club, I want to join; hope is the key, isn't it?
Meagan
> Some here will say to open the capsules and count out grains of the drug. Personally, I would say stick it out on the 20mg capsules, and just remind yourself that the adjustment phase issues are likely to pass. I know it's hard -- been there, doing that now with a new drug myself -- but it is possible.
>
> One reason that I suggest sticking with the 20mg capsule, rather than trying to split the dose, is that it may shorten the adjustment phase for you. If you split the capsules, you'll end up going through the adjustment at every increase, which can take much longer. Sticking with the full 20mg from the start means going through ONE adjustment period. For me, the convenience and the shortened adjustment are just easier to deal with.
>
> I know it's hard to do, because -- as I've said -- I've done it myself. And I'm doing it now. My therapist and I talk about the difficulties of sticking it out, and I have a few BabbleBuddies I discuss it with. I think we should form a little Sticking It Out club on the board, so you're welcome to join us...
Posted by kezia on December 13, 2007, at 11:19:53
In reply to Re: need help,please. Minimum dose too strong » Racer, posted by Meagan on December 13, 2007, at 11:11:53
I agree with Racer - sticking it out is a good option, although it can seem almost unbearable at times. The first AD I was on (which, incidentally, ended up working extremely well for me) caused me a lot of grief in the start-up phase. The first 3 were horrid - increased anxiety (my anxiety was already through the roof as it was), stomach problems, mood swings (crying one minute, angry the next). My doctor calmed me down and convinced me to stick it out and I am glad I did. She also gave me a very small script for Xanax to use for the increased anxiety. Once I adjusted to the AD, I did not need the Xanax (well, occasionally for really bad PMS anxiety). It may not seem like it now, but it can be worth it in the long run to try to muster up the emotional strength to get through the adjustment, side-effect ridden stage of a new AD - particularly one that holds promise.
Good luck to you. I hope it ends up working well for you.
Posted by Meagan on December 13, 2007, at 11:33:16
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by kezia on December 13, 2007, at 11:19:53
Thank you, thank you, Kezia; it's so good to hear that the AD that gave you the worst side effects ultimately worked for you! I just took some ativan, which I have available to me from my pdoc on an "as needed" basis; sometimes it's hard to know just when the time is to consider it needed, and I guess it's now.
It's ironic, isn't it, that I do indeed need to muster up emotional strength in order to find a remedy that will help me maintain emotional strength.
Thanks for helping me get through another day on it.
Meagan
> I agree with Racer - sticking it out is a good option, although it can seem almost unbearable at times. The first AD I was on (which, incidentally, ended up working extremely well for me) caused me a lot of grief in the start-up phase. The first 3 were horrid - increased anxiety (my anxiety was already through the roof as it was), stomach problems, mood swings (crying one minute, angry the next). My doctor calmed me down and convinced me to stick it out and I am glad I did. She also gave me a very small script for Xanax to use for the increased anxiety. Once I adjusted to the AD, I did not need the Xanax (well, occasionally for really bad PMS anxiety). It may not seem like it now, but it can be worth it in the long run to try to muster up the emotional strength to get through the adjustment, side-effect ridden stage of a new AD - particularly one that holds promise.
>
> Good luck to you. I hope it ends up working well for you.
Posted by Phillipa on December 13, 2007, at 12:13:12
In reply to Re: need help,please. Minimum dose too strong » kezia, posted by Meagan on December 13, 2007, at 11:33:16
Some not all pdocs think as mine does that taking lower doses and working up eliminates a low of side effects and makes the transition much more tolerable. As an example with luvox normal starting is 50mg . I take that and she would like me to increase but said do it very slowly in l2.5mg increments. And I've taken benzos so long they don't work anymore . So do what your gut says to do and good luck to you. Phillipa
Posted by Meagan on December 13, 2007, at 12:39:05
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by Phillipa on December 13, 2007, at 12:13:12
Thank you Phillipa - more good advice.
Posted by Phillipa on December 13, 2007, at 12:40:58
In reply to Re: need help,please. Minimum dose too strong » Phillipa, posted by Meagan on December 13, 2007, at 12:39:05
You're welcome. I wish you much success. Phillipa
Posted by bleauberry on December 13, 2007, at 17:10:03
In reply to need help,please. Minimum dose too strong, posted by Meagan on December 13, 2007, at 10:35:49
You can easily customize the dose of cymbalta. Many of us have done it. If you are tough as nails, then try to stick it out at 20mg. For a smoother transition with negligible impact on your daily functioning, start at lower doses and gradually increase about every 3 or 4 days. The time it takes to get to your target dose will be longer, but the ride much smoother. The whole time, adjustments to your brain receptors that 20mg would do are already underway at lower doses. It's not as if you have to wait until you hit 20mg before anything changes.
Some people on prozac do best on 5mg or 10mg prozac, which if compared pound for pound to cymbalta would be a cymbalta dose considerably lower than 20mg. Same with St Johns Wort at 150mg to 300mg, instead of 900mg. Or zoloft at 25 mg instead of 50mg or a 100mg. Etc Etc. I heard of a girl who had to take lexapro as a liquid because her perfect dose was 3.5mg. Any higher she felt worse, any lower it didn't work.
Anyway, here's how to do it. The cymbalta capsule is not time release. Inside the capsule are hundreds of tiny beads. Each one has a time release coating on it. How to measure your dose? One milligram is approximately 9 to 11 beads. I have actually meticulously precisely hand counted all the beads in various sized capsules.
Some came out to 9 beads=1mg, others 11 beads=1mg, most were 10 beads = 1mg.Do not chew the beads. The outer coating is to protect the drug inside from stomach acid. It is meant to dissolve in the intestines. I simply dampen my fingertip a slight bit, poke the beads that are in a small bowl, count them on my fingertip, touch them to my tonque, and swallow with water. Do it a couple times adding up the beads until you have your desired dose. Another way is to sprinkle the beads on something soft like apple sauce, pudding, or ice cream, and swallow it whole without chewing. Though harder to do, you could buy empty gel capsules and put your desired amount of beads into those.
Personally, I am so darn sensitive I had to start with 1mg the first day, 2mg the second day, 3mg the third day, waited a few days, and then 5mg, about a week later I was at 10mg. That's as high as I ever got. The drug just felt so overwhelmingly powerful to me. But that's common for mercury toxic people, like me. For some of us, the need to customize small doses is a necessity not a choice.
Posted by Meagan on December 13, 2007, at 18:15:15
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by bleauberry on December 13, 2007, at 17:10:03
Bleauberry,
You must be a jeweler by trade! How do you store the left over beads? In a small bowl with plastic wrap over it? I thank you for this tip. I think I will try it tomorrow morning; it's good to know there are med-sensitive people like me out there.
I am annoyed with my pdoc because he knows how sensitive I am to meds, yet he never offered me an alternative. And as you say, for some people, it's a necessity not a choice.
I just don't get why the literature on this med says not to break open the capsule, that it needs to be swallowed whole - if the capsule isn't time release, just the coating around the beads, I don't see the problem and the reason for the prohibition about opening the capsule. Do you think that's simply standard "cya" language?Thank you again bleauberry,
Meagan
> You can easily customize the dose of cymbalta. Many of us have done it. If you are tough as nails, then try to stick it out at 20mg. For a smoother transition with negligible impact on your daily functioning, start at lower doses and gradually increase about every 3 or 4 days. The time it takes to get to your target dose will be longer, but the ride much smoother. The whole time, adjustments to your brain receptors that 20mg would do are already underway at lower doses. It's not as if you have to wait until you hit 20mg before anything changes.
>
> Some people on prozac do best on 5mg or 10mg prozac, which if compared pound for pound to cymbalta would be a cymbalta dose considerably lower than 20mg. Same with St Johns Wort at 150mg to 300mg, instead of 900mg. Or zoloft at 25 mg instead of 50mg or a 100mg. Etc Etc. I heard of a girl who had to take lexapro as a liquid because her perfect dose was 3.5mg. Any higher she felt worse, any lower it didn't work.
>
> Anyway, here's how to do it. The cymbalta capsule is not time release. Inside the capsule are hundreds of tiny beads. Each one has a time release coating on it. How to measure your dose? One milligram is approximately 9 to 11 beads. I have actually meticulously precisely hand counted all the beads in various sized capsules.
> Some came out to 9 beads=1mg, others 11 beads=1mg, most were 10 beads = 1mg.
>
> Do not chew the beads. The outer coating is to protect the drug inside from stomach acid. It is meant to dissolve in the intestines. I simply dampen my fingertip a slight bit, poke the beads that are in a small bowl, count them on my fingertip, touch them to my tonque, and swallow with water. Do it a couple times adding up the beads until you have your desired dose. Another way is to sprinkle the beads on something soft like apple sauce, pudding, or ice cream, and swallow it whole without chewing. Though harder to do, you could buy empty gel capsules and put your desired amount of beads into those.
>
> Personally, I am so darn sensitive I had to start with 1mg the first day, 2mg the second day, 3mg the third day, waited a few days, and then 5mg, about a week later I was at 10mg. That's as high as I ever got. The drug just felt so overwhelmingly powerful to me. But that's common for mercury toxic people, like me. For some of us, the need to customize small doses is a necessity not a choice.
Posted by sunnydays on December 13, 2007, at 18:19:54
In reply to Re: need help,please. Minimum dose too strong » bleauberry, posted by Meagan on December 13, 2007, at 18:15:15
I know for Effexor XR, opening the capsule and taking the beads or whatever directly can cause vomiting and make people feel extremely sick as the drug gets into the system too quickly. Try 20mg first - remember what Racer said about sticking it out and only going through one adjustment phase? Maybe you'll be pleasantly surprised and not have side effects. But if you do have side effects, try to stick it out a little bit, even though it's hard.
sunnydays
Posted by Meagan on December 13, 2007, at 18:37:19
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by sunnydays on December 13, 2007, at 18:19:54
Dear Sunnydays,
I like your name.
The Cymbalta I'm taking is Cymbalta Delayed Release capsules; you're definitely right - it sounds like its mechanism is similar to Effexor XR and I would be better off NOT opening the capsules for the reasons you stated.
Thanks too,for reminding me what Racer said, about sticking it out and dealing with just one adjustment phase. I'm back on track.
Meagan
> I know for Effexor XR, opening the capsule and taking the beads or whatever directly can cause vomiting and make people feel extremely sick as the drug gets into the system too quickly. Try 20mg first - remember what Racer said about sticking it out and only going through one adjustment phase? Maybe you'll be pleasantly surprised and not have side effects. But if you do have side effects, try to stick it out a little bit, even though it's hard.
>
> sunnydays
Posted by Phillipa on December 13, 2007, at 19:20:40
In reply to Re: need help,please. Minimum dose too strong » sunnydays, posted by Meagan on December 13, 2007, at 18:37:19
Meagan if you use the Dr. Bob side of google and google cymbalta you find a lot of people opened the capsules and mixed with something soft and swallowed them whole as the capsules are what is time release never ever bite them swallow whole. The capsules are gelatin and disolve in your stomach right away. Also if you like you can put the tiny pieces back in the capsule close it and then save the rest and get the cheap empty capsules in a vitamin shoppe. Luckily first time I took it didn't need to do this. Second time couldn't handle the dose and the pdoc took me off should have taken a very small dose. Phillipa
Posted by sunnydays on December 13, 2007, at 19:45:39
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by Phillipa on December 13, 2007, at 19:20:40
Phillipa - From http://www.drugs.com/cymbalta.html
Do not crush, chew, break, or open a delayed-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. It may take 4 weeks or longer for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using Cymbalta without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Cymbalta at room temperature away from moisture and heat.
I have heard lots of problems with medicine being released too quickly if a delayed-release capsule is opened. I would ask a doctor's advice before opening such a capsule.
sunnydays
Posted by Phillipa on December 13, 2007, at 19:58:32
In reply to Re: need help,please. Minimum dose too strong » Phillipa, posted by sunnydays on December 13, 2007, at 19:45:39
Thanks sunnydays let me see what happened when babblers did it. I also did it coming off the first time no side effects. Phillipa
Posted by Phillipa on December 13, 2007, at 20:04:33
In reply to Re: need help,please. Minimum dose too strong » Phillipa, posted by sunnydays on December 13, 2007, at 19:45:39
Goggled it and believe it or not the first it seems was our Scott when withdrawing from the med as advise to others. Not saying it's correct or not who knows? But it worked for me and them. Agree ask doc first though. I did ask mine he said it was kindda dumb but if I wanted to I could. Phillipa
Posted by bleauberry on December 13, 2007, at 20:41:58
In reply to Re: need help,please. Minimum dose too strong » Phillipa, posted by sunnydays on December 13, 2007, at 19:45:39
The post copied below is false.
Cymbalta is not a delayed release capsule. It is a plain ole capsule with delayed release beads inside it. Breaking or opening the pill does not cause too much of it to be released all at one time any more than if you swallowed the whole thing. Whether you swallow beads from the capsule, or swallow the whole capsule, the beads themselves are not going to be released until they reach the intestines. With a capsule you get 200 beads releasing all at once. With a custom 5mg you get 50 beads releasing all at once.The term "delayed release capsule" is misleading. Sure it is true that cymbalta is a delayed release medicine, but it is not the capsule that does that. Each bead inside the capsule has an enteric coating, which the capsule itself does not have.
More people than I can remember have used this neat trick when titrating up or weaning off cymbalta or effexor, and the strategy proved to be a lifesaver for them saving tons of agony.
Obviously the drug companies do not want you doing this because it lowers their sales.
> Phillipa - From http://www.drugs.com/cymbalta.html
>
> Do not crush, chew, break, or open a delayed-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. It may take 4 weeks or longer for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using Cymbalta without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Cymbalta at room temperature away from moisture and heat.
>
> I have heard lots of problems with medicine being released too quickly if a delayed-release capsule is opened. I would ask a doctor's advice before opening such a capsule.
>
> sunnydays
Posted by sunnydays on December 13, 2007, at 22:52:56
In reply to Re: need help,please. Minimum dose too strong, posted by bleauberry on December 13, 2007, at 20:41:58
Ok, this is from the NIH... not exactly a drug company looking to make sales.
Cymbalta should be swallowed whole and should not be chewed or crushed, nor should the contents be sprinkled on food or mixed with liquids. All of these might affect the enteric coating.
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5716
I'm not trying to be difficult, and I truly believe that people have probably done this and been fine. I would hate to see someone hurt unnecessarily, however. That's my biggest concern with doing things against the advice of people who have done scientific studies on the coatings of these drugs.
sunnydays
Posted by Phillipa on December 13, 2007, at 23:55:18
In reply to Re: need help,please. Minimum dose too strong » bleauberry, posted by sunnydays on December 13, 2007, at 22:52:56
I do know that the capsules themselves are made of gelatan sp? and breakdown in the stomach. Phillipa
Posted by Glydin on December 14, 2007, at 6:48:06
In reply to need help,please. Minimum dose too strong, posted by Meagan on December 13, 2007, at 10:35:49
> Should I take an ativan and try to stick it out at the 20 mg dose? I know I need to give this med a fair trial, like I did with the others, but every side effect, even if it is "mild" and temporary, scares me into wanting to quit before I give the med a chance. I'm just sick of all this turmoil.
>
> Thanks for any help.
>
> Meagan
~~~ I think going the "stick to it" route is the best. I discovered this after several "trials" of trash it before the startup even really started...... I understand well how appealing that is. Using a benzo helped me alot and smoothed the edges somewhat. Getting thur the getting thur is tough but can be well well worth it in the long haul.I'm not fond of the idea of home compounding to "work up" to a therapeudic dosing. I think that might work for folks who are determined to "work up" but I have found some folks just end up staying stuck on a dose that probably isn't effective.
Weaning off a med I think is a different situation and decreasing in small amounts may indeed be the way to go. But, I found on startups with AD's, the best *for me* was to adjunct with a benzo. Increased anxiety on startup was a given for me no matter the dosing.
Posted by rskontos on December 14, 2007, at 8:38:50
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by Glydin on December 14, 2007, at 6:48:06
I opened the capsules of cymbalta when I was tapering off of it and took out beads in order to go down from 60 to zero over a 3- 4 month period. It is true it is a delayed release from the beads themselves. Not the outside. I asked the pharmacist. It did not make me vomit from doing that. Now cymbalta itself affects the gut and can do that no matter the dosage you on it. It works on serotonin which is produced in the gut as well in the brain. They post that to protect themselves. Some people I know dissolved cymbalta in liquid and only drank a portion of it in order to taper off slowly. So there are numerous ways to reduce a dosage that works. Not perfectly but then the drug itself doesn't always work perfectly. I am suppose to be on 20 mg. of lexapro and if I did that I am not sure I would ever be awake. Cymbalta too made me sleep all the time. At 60 mg of cymbalta I did notice eventually the tiredness went away if that is one of your side effects. I am sorry at this point in the thread I don't remember what you said about what you were having problems with the cymbalta about being too strong. I was on it for a year. Some side effects went away some didnt. If you want to list those that are making you feel it is too much I will tell you my experience of those that went away for me and those that stayed. And I can tell why I did not stay on the drug. My depression was a secondary symptom to my real issues though and the gp prescribing the cymbalta didn't get to the root of the problem.
Good luck let us know how you are and what you decide to do.
rk
Posted by Meagan on December 14, 2007, at 10:17:09
In reply to Re: need help,please. Minimum dose too strong » Meagan, posted by Glydin on December 14, 2007, at 6:48:06
Glydin,
you're right, benzos are esssential for me at this point, and i took 1 mg during the day to fight off the anxiety i had with taking the med, and 1 mg at night to help me sleep, since i'm experiencing insomnia. And today is my 3rd day on cymbalta, and i stuck with 20 mg again instead of being tempted to cut the dose.
I don't know if things are getting better, but they're not getting worse. And when you're "getting thru the getting thru" i gues that's a good thing!
Thanks again, Glydin, for your advice.
Meagan
>
> ~~~ I think going the "stick to it" route is the best. I discovered this after several "trials" of trash it before the startup even really started...... I understand well how appealing that is. Using a benzo helped me alot and smoothed the edges somewhat. Getting thur the getting thur is tough but can be well well worth it in the long haul.
>
> I'm not fond of the idea of home compounding to "work up" to a therapeudic dosing. I think that might work for folks who are determined to "work up" but I have found some folks just end up staying stuck on a dose that probably isn't effective.
>
> Weaning off a med I think is a different situation and decreasing in small amounts may indeed be the way to go. But, I found on startups with AD's, the best *for me* was to adjunct with a benzo. Increased anxiety on startup was a given for me no matter the dosing.
Posted by Meagan on December 14, 2007, at 10:46:14
In reply to Re: need help,please. Minimum dose too strong, posted by rskontos on December 14, 2007, at 8:38:50
Hello rskontos,
I'm on 20 mg of cymbalta, and this is my third day on it. My main side effects are weakness, insomnia and mild to moderate headache. The insomnia I can take care of with a benzo. I tolerate the headache, but I am most concerned about the weakness I feel. I go to the gym and am exhausted after my workout, rather than energized. I've had to drop my weights (which weren't very high to begin with) and I do my workout very slowly.
Did you experience weakness, and if so, did it go away?
Like you, I know, (and fortunately my pdoc knows) that I have other issues that realistically contribute to my depression, but that is not the entire cause of it. So I need something - I take other meds that have worked for me for a long time with no side effects; problem was when my prozac stopped working, and that's why I'm on Cymbalta right now.
My pdoc has no plans to increase my dose, and I'm only on day 3 of it; i need to give it a decent trial, but if the weakness doesn't go away, it is not worth it to me to be on it.
If I have to go off it, I'm dreading withdrawal, and I thank you for sharing the info your phramacist told you about the beads; it's good to know there are options that help ease the withdrawal process.
Thanks again,
Meagan
> I opened the capsules of cymbalta when I was tapering off of it and took out beads in order to go down from 60 to zero over a 3- 4 month period. It is true it is a delayed release from the beads themselves. Not the outside. I asked the pharmacist. It did not make me vomit from doing that. Now cymbalta itself affects the gut and can do that no matter the dosage you on it. It works on serotonin which is produced in the gut as well in the brain. They post that to protect themselves. Some people I know dissolved cymbalta in liquid and only drank a portion of it in order to taper off slowly. So there are numerous ways to reduce a dosage that works. Not perfectly but then the drug itself doesn't always work perfectly. I am suppose to be on 20 mg. of lexapro and if I did that I am not sure I would ever be awake. Cymbalta too made me sleep all the time. At 60 mg of cymbalta I did notice eventually the tiredness went away if that is one of your side effects. I am sorry at this point in the thread I don't remember what you said about what you were having problems with the cymbalta about being too strong. I was on it for a year. Some side effects went away some didnt. If you want to list those that are making you feel it is too much I will tell you my experience of those that went away for me and those that stayed. And I can tell why I did not stay on the drug. My depression was a secondary symptom to my real issues though and the gp prescribing the cymbalta didn't get to the root of the problem.
>
> Good luck let us know how you are and what you decide to do.
>
> rk
Posted by rskontos on December 14, 2007, at 11:30:44
In reply to Re: need help,please. Minimum dose too strong » rskontos, posted by Meagan on December 14, 2007, at 10:46:14
Hello rskontos,
I'm on 20 mg of cymbalta, and this is my third day on it. My main side effects are weakness, insomnia and mild to moderate headache. The insomnia I can take care of with a benzo. I tolerate the headache, but I am most concerned about the weakness I feel. I go to the gym and am exhausted after my workout, rather than energized. I've had to drop my weights (which weren't very high to begin with) and I do my workout very slowly.
Did you experience weakness, and if so, did it go away?
**Yeah the weakness did go away, but I never experience the high that most people do. I don't on any SSRI. I usually get flat or numbed out. That is why I quit cymbalta it made me so numb and that is a problem for me anyway with my diagnosis. I was so emotionless it was bad. And it messed my gi tract up really bad. But I have collitis. So it would affect me that way.
It took me probably several weeks to adjust to the tiredness effects of cymbalta which is what you are feeling. They do go away after awhile at least for me. I was able to return to my normal stuff go to work etc.
Like you, I know, (and fortunately my pdoc knows) that I have other issues that realistically contribute to my depression, but that is not the entire cause of it. So I need something - I take other meds that have worked for me for a long time with no side effects; problem was when my prozac stopped working, and that's why I'm on Cymbalta right now.My pdoc has no plans to increase my dose, and I'm only on day 3 of it; i need to give it a decent trial, but if the weakness doesn't go away, it is not worth it to me to be on it.
If I have to go off it, I'm dreading withdrawal, and I thank you for sharing the info your phramacist told you about the beads; it's good to know there are options that help ease the withdrawal process.
Thanks again,
Meaga
You are welcome, Withdrawal is hard on this one so when you do be sure to look around for advice supplements do help as well as other stuff. The brain zaps are the worst and the flu like stuff. Anyway, I hope it works for you. I would go ahead and stick it out because as my neuro says you have already altered your brain chemistry at this point give it time to see if it will work because going off it now also alters your brain chemistry. After about 10 weeks you should know. The literature says 12 weeks, neuro will say 2-3 months, I say 2 months. You have to make your own decision based on your doc's information and then how your body tells you it feels. Listen to yourself too. Don't discount what the body tells you either. Especially if you start getting a itchy rash that is raised bumps. This could mean you are having a reaction to it. My neuro says this is something you want a doc to look at cause it can mean it not agreeing with your system. Your liver dumps excessive meds through the skin sometimes when it needs to....this is my quick and unscientific explanation. Anyway, itchy rashes can be a early indication something is up. Take care, let us know.
rk
Posted by bleauberry on December 14, 2007, at 17:31:08
In reply to Re: need help,please. Minimum dose too strong » bleauberry, posted by sunnydays on December 13, 2007, at 22:52:56
Sorry sunnydays, it bothers me when beaurocrats write things with particular words and phrasings that make what they are saying sound like it is from a fool-proof bible, or they sound as genuine as the slickest salesman there ever was.
"Might", "Should", Should not"....versus "Will", "Must", "Must Not". Check out the ingredients. The capsule is gelatin.
I think some people get the concept of exteneded release and delayed release mixed up. Cymbalta is delayed release, not extended release. Its release is delayed until it reaches the intestines, protected by powerful bead coatings that even stomach acid (really worried about applesauce or juice?) can't destroy. You cannot use the strategy we are talking about here with extended release. That is a whole different thing.
If someone really wants a lower dose, for whatever reason, and they are confused by beaurocratic writings, fine, dump the beads out, count how many you want (10 = 1mg), put them back in the capsule, swallow it whole with water. All set. Good as factory.
> Ok, this is from the NIH... not exactly a drug company looking to make sales.
>
> Cymbalta should be swallowed whole and should not be chewed or crushed, nor should the contents be sprinkled on food or mixed with liquids. All of these might affect the enteric coating.
>
> http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5716
>
> I'm not trying to be difficult, and I truly believe that people have probably done this and been fine. I would hate to see someone hurt unnecessarily, however. That's my biggest concern with doing things against the advice of people who have done scientific studies on the coatings of these drugs.
>
> sunnydays
Posted by Meagan on December 14, 2007, at 18:08:58
In reply to Re: need help,please. Minimum dose too strong, posted by bleauberry on December 14, 2007, at 17:31:08
Bleauberry,
Thanks for clarifying the difference between "extended release" and "delayed release".
Meagan
>
> "Might", "Should", Should not"....versus "Will", "Must", "Must Not". Check out the ingredients. The capsule is gelatin.
>
> I think some people get the concept of exteneded release and delayed release mixed up. Cymbalta is delayed release, not extended release. Its release is delayed until it reaches the intestines, protected by powerful bead coatings that even stomach acid (really worried about applesauce or juice?) can't destroy. You cannot use the strategy we are talking about here with extended release. That is a whole different thing.
>
> If someone really wants a lower dose, for whatever reason, and they are confused by beaurocratic writings, fine, dump the beads out, count how many you want (10 = 1mg), put them back in the capsule, swallow it whole with water. All set. Good as factory.
>
>
>
> > Ok, this is from the NIH... not exactly a drug company looking to make sales.
> >
> > Cymbalta should be swallowed whole and should not be chewed or crushed, nor should the contents be sprinkled on food or mixed with liquids. All of these might affect the enteric coating.
> >
> > http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5716
> >
> > I'm not trying to be difficult, and I truly believe that people have probably done this and been fine. I would hate to see someone hurt unnecessarily, however. That's my biggest concern with doing things against the advice of people who have done scientific studies on the coatings of these drugs.
> >
> > sunnydays
>
>
This is the end of the thread.
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